Misuse and Abuse of Opioid Analgesics – the Role of the Internet H. Siemann, J. Schnell, N. Scherbaum LVR Hospital Essen, Clinic for Dependent Behavior and Addiction Medicine University of Duisburg-Essen, Germany Misuse and Abuse of Opioid Analgesics – the Role of the Internet 09/18/2009 Opioid Analgesics • Prescription Drugs – Tramadol, Tilidine, Codeine, Loperamide – Easy to prescribe • Schedule III Drugs according to the German Narcotics Act (BtmG) – Morphine, Methadone, Fentanyl, Buprenorphine, Oxycodone – Special conditions to be fulfilled for a valid presciption Holger Siemann ([email protected]) 2 Misuse and Abuse of Opioid Analgesics – the Role of the Internet 09/18/2009 Prescription Rate Holger Siemann ([email protected]) 3 Misuse and Abuse of Opioid Analgesics – the Role of the Internet 09/18/2009 Non-Scheduled Opioids • Tramadol – Pain management (post-surgery treatment, injury treatment) • Tilidine + Naloxone (Valoron N®) – Higher analgesic potency – Prevention of parenteral drug abuse by combination with the µ-receptor antagonist Naloxone Holger Siemann ([email protected]) 4 Misuse and Abuse of Opioid Analgesics – the Role of the Internet 09/18/2009 Aim of the Study • To assess the role of the internet regarding the abuse of prescription opioids – Role as a trading platform – Role as an information system Holger Siemann ([email protected]) 5 Misuse and Abuse of Opioid Analgesics – the Role of the Internet 09/18/2009 Methods • Analysis of the first 50 websites provided by the leading search engine Google for the 3 search terms: – Tramal (registered trademark) – Tramadol – Tramadol rezeptfrei (no need for a valid prescription) • 150 websites • No focus on Tilidine due to the combination with Naloxone and the low abuse potential Holger Siemann ([email protected]) 6 Misuse and Abuse of Opioid Analgesics – the Role of the Internet 09/18/2009 Results • Analysis of 150 websites • About 800 webpages • Following some discussion boards in addition Holger Siemann ([email protected]) 7 Misuse and Abuse of Opioid Analgesics – the Role of the Internet 09/18/2009 Site Ownership • High number of commercial websites • Only small amount of private and institutional/governmental websites Holger Siemann ([email protected]) 8 Misuse and Abuse of Opioid Analgesics – the Role of the Internet 09/18/2009 Trading • Smart/Head/Herbal shops focus on herbal drugs • Online pharmacies focus on life-style drugs Holger Siemann ([email protected]) 9 Misuse and Abuse of Opioid Analgesics – the Role of the Internet 09/18/2009 Role as a Trading Platform • Only a low number of opioid drug distributing websites – Interdiction of „online“ prescriptions in Germany need for valid prescription 2 sites from the Netherlands offering online prescription – Need for a credit card – Delayed access – Suspicion because of high quality fake sites (credit card number phising, money transfer) Holger Siemann ([email protected]) 10 Misuse and Abuse of Opioid Analgesics – the Role of the Internet 09/18/2009 Role as an Information System • Mainly a pro-drug consumption attitude – Many commercial sites – Use of tramadol as a regular analgesic drug: „if my doctor is prescribing this drug it can‘t be harmful“ • Information about methods to obtain opioid analgesics Holger Siemann ([email protected]) 11 Misuse and Abuse of Opioid Analgesics – the Role of the Internet 09/18/2009 Examples • Tilidine + Naloxone: – Different boiling points – Usage of toaster to separate both substances from each other Inhalation of Tilidine • Tramadol: – How to get your doctor to prescribe an opioid analgesic (e.g. chronic pain) – How to forge a prescription Holger Siemann ([email protected]) 12 Thank you! .